Prescribing "placebo treatments": results of national survey of US internists and rheumatologists.
OBJECTIVE
To describe the attitudes and behaviours regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.


METHODS
Cross sectional mailed survey.


METHODS
Physicians' clinical practices.


METHODS
1200 practising internists and rheumatologists in the United States.


METHODS
Investigators measured physicians' self reported behaviours and attitudes concerning the use of placebo treatments, including measures of whether they would use or had recommended a "placebo treatment," their ethical judgments about the practice, what they recommended as placebo treatments, and how they typically communicate with patients about the practice.


RESULTS
679 physicians (57%) responded to the survey. About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Most physicians (399, 62%) believed the practice to be ethically permissible. Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments, while large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period. Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%); only rarely do they explicitly describe them as placebos (18, 5%).


CONCLUSIONS
Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed US internists and rheumatologists. Vitamins and over the counter analgesics are the most commonly used treatments. Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.
Tilburt
Jon C
JC
Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA. tilburt.jon@mayo.edu
Emanuel
Ezekiel J
EJ
Kaptchuk
Ted J
TJ
Curlin
Farr A
FA
Miller
Franklin G
FG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000188:drug therapy*; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs; D010919:Placebos / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D012219:Rheumatology; D014481:United States
D004366:Nonprescription Drugs; D010919:Placebos